BlueCard links participating health-care providers and the Blue Cross and Blue Shield
Plans throughout the country with a single electronic network for professional outpatient
and inpatient claims processing and reimbursement. The program allows participating
Blue Cross and Blue Shield providers in every state to submit claims for indemnity
and PPO patients who are enrolled through another Blue Plan to their local Blue
Cross and Blue Shield Plan.
Through the BlueCard program, providers can submit claims for Blue Cross and Blue
Shield members they are treating that currently are covered by another Blue Cross
and Blue Shield plan directly to Arkansas Blue Cross and Blue Shield electronically
through AHIN. If you are an Arkansas provider, Arkansas Blue Cross is your sole
necessary contact for all Blue Cross and Blue Shield claims submissions, payments,
adjustments, services and inquiries (unless otherwise instructed by Arkansas Blue
Cross or another Blue Plan).
If you provide health-care services to a member of another Blue Plan's Medicare
Advantage private fee-for-service (PFFS) plan, you do so under that Blue Plan's
Terms and Conditions. Medicare Advantage PFFS Terms and Conditions may vary for
each Blue Cross and/or Blue Shield plan, and we advise you to review the Terms and
Conditions before providing services to Medicare Advantage PFFS plan members from
out of state.
View Terms and Conditions for out-of-state
Medicare Advantage private fee-for-service plan members.
BlueCard applies to inpatient, outpatient and professional services. BlueCard does
not yet apply to the following:
When members from other Blue Cross and Blue Shield Plans arrive at your office or
facility, be sure to ask them for their current membership ID card. The two main
identifiers for BlueCard members are the alpha prefix and, for eligible PPO members,
the "PPO in a suitcase" logo.
The three-character alpha prefix at the beginning of the member's identification
number is the key element used to identify and correctly route out-of-area BlueCard
claims. The alpha prefix identifies the Blue Cross and Blue Shield company ("Plan")
or national account to which the member belongs.
There are two types of alpha prefixes: Plan-specific and account-specific.
Plan-specific alpha prefixes are assigned to every Plan and start with X,
Y, Z or Q. The first two positions indicate the Plan to which the member belongs,
while the third position identifies the product in which the member is enrolled.
Account-specific prefixes are assigned to centrally processed national accounts.
National accounts are employer groups that have offices or branches in more than
one area but offer uniform coverage benefits to all of their employees. Account-specific
alpha prefixes start with letters other than X, Y, Z or Q. Typically, a national-account
alpha prefix will relate to the name of the group. All three positions are used
to identify the national account.
International alpha prefixes can be seen on identification cards from foreign
Blue Cross and Blue Shield members. These ID cards will also contain three-character
alpha prefixes. For example, JIS indicates Blue Cross and Blue Shield of Israel
members. The BlueCard claims process for international members is the same as that
for domestic Blue Cross and Blue Shield members.
You'll immediately recognize BlueCard PPO members by the special "PPO in a suitcase"
logo on their membership card. BlueCard PPO members are Blue Cross and Blue Shield
members whose PPO benefits are delivered through the BlueCard Program. It is important
to remember that not all PPO members are BlueCard PPO members, only those whose
membership cards carry this logo. Members traveling or living outside of their Blue
Plan's area receive the PPO level of benefits when they obtain services from designated
Some identification cards may not have an alpha prefix. This may indicate that the
claims are handled outside the BlueCard program. Look for instructions or a telephone
number on the back of the member's ID card for information on how to file these
It is very important to capture all ID-card data at the time of service. This is
critical for verifying membership and coverage. We suggest that you make copies
of the front and back of the ID card and pass this key information on to your billing
staff. Do not make up alpha prefixes.
If you are not sure about your participation status (PPO or non-PPO), call Arkansas
Blue Cross and Blue Shield.
Call 1-800-676-BLUE (2583).
With the member's most current ID card in hand, you can check available membership
and coverage information by calling BlueCard Eligibility® at 1-800-676-BLUE (2583).
An operator will ask you for the alpha prefix on the member's ID card and will connect
you to the appropriate membership and coverage unit at the member's Blue Cross and
Blue Shield Plan.
If you are unable to locate an alpha prefix on the member's ID card, check for a
telephone number on the back of the ID card.
Providers should remind patients from other Blue Plans that they are responsible
for obtaining precertification or preauthorization for coverage of their services
from their Blue Cross and Blue Shield Plan. You also may choose to contact the member's
Plan on behalf of the member. If you choose to do so, refer to the precertification
or preauthorization phone number on the back of the member's ID card.
Blue Cross Coverage Policy is available on the Provider page of this Web
If you are an Arkansas provider, always submit BlueCard claims electronically through
AHIN or mail to Arkansas Blue Cross and Blue Shield, P.O. Box 2181, Little Rock,
AR 72203-2181. The only exception to this is if you contract with the member's
Plan (for example, in contiguous counties or overlapping service areas), in which
case you should file the claim directly to the member's Plan.
Be sure to include the member's complete ID number when you submit the claim. The
complete ID number includes the three-character alpha prefix. Do not make up alpha
prefixes. Incorrect or missing alpha prefixes and member identification
numbers delay claims processing.
After Arkansas Blue Cross receives a claim, it will electronically route the claim
to the member's Blue Cross and Blue Shield Plan. The member's Plan then processes
the claim and approves payment or provides an explanation why a service is not covered,
and Arkansas Blue Cross will remit payment based on the Arkansas Blue Cross applicable
fee schedule, and the member's benefits from the other Blue Plan or provide information
as to why the service was not eligible.
If you are a non-PPO (traditional) provider and are presented with an identification
card with the "PPO in a suitcase" logo on it, you should still accept the card and
file with your local Blue Cross and Blue Shield Plan. You will still be given the
appropriate traditional pricing and the applicable member benefits from the other
The claim submission process for international Blue Cross and Blue Shield members
is the same as for domestic Blue Cross and Blue Shield members.
If you are a health-care provider who offers products, materials, informational
reports and remote analyses or services and are not present in the same physical
location as a patient, you are considered an indirect, support or remote provider.
Examples include, but are not limited to, prosthesis manufacturers, durable medical
equipment suppliers, independent or chain laboratories or telemedicine providers.
In some cases, a member's Blue Cross and Blue Shield Plan may suspend a claim because
medical review or additional information is necessary. When resolution of claim
suspensions requires additional information from you, Arkansas Blue Cross may either
ask you for the information or give the member's Plan permission to contact you
If a member contacts you, tell the member to contact their Home Blue Cross and Blue
Shield Plan. Refer them to the front or back of their ID card for a customer-service
The member's Home Plan should not be contacting you directly. However, if the member's
Plan does ask you to send them another copy of the member's claim, refer them to
Arkansas Blue Cross toll free at 1-800-800-4298.
Even though Arkansas Blue Cross and Blue Shield will serve as your sole point of
contact for BlueCard claims, please understand that this does not mean that Arkansas
Blue Cross and Blue Shield assumes the obligation to pay or guarantee payment of
any claims for services to the members of other Blue Cross and Blue Shield Plans,
i.e., the Home Plans. Sole responsibility for payment of all BlueCard claims for
members covered by other Blue Cross and Blue Shield Plans (non-Arkansas Blue Cross
and Blue Shield BlueCard members) shall remain at all times with the applicable
Blue Cross and Blue Shield Plan, i.e., the Home Plan. Arkansas Blue Cross and Blue
Shield acts merely as the Host Plan for purposes of facilitating ease-of-service
to the Home Plan's members, and assisting in your communications with that Home
All coverage determinations for non-Arkansas Blue Cross and Blue Shield BlueCard
members are the responsibilities and decisions of the Home Plan, not Arkansas Blue
Cross and Blue Shield. Providers agree to look solely to the Home Plan for non-Arkansas
Blue Cross and Blue Shield BlueCard members for payment with respect to any services
to such members.
Please note that Arkansas Blue Cross and Blue Shield does not share ownership or
governance with any other Blue Cross and Blue Shield Plan; Arkansas Blue Cross and
Blue Shield is an entirely independent, separate not-for-profit mutual insurance
company, organized in the State of Arkansas and owned by its policyholders. The
only association between Arkansas Blue Cross and Blue Shield and other Blue Cross
and Blue Shield Plans is that each separate company has been licensed by the Blue
Cross and Blue Shield Association to use the registered “Cross” and “Shield” service
marks in their separate business operations.
The BlueCard Program is a cooperative effort among these separate, independent licensees
of the Blue Cross and Blue Shield Association but it does not in any way obligate
Arkansas Blue Cross and Blue Shield to fund any benefits or become liable for any
activities or omissions of any other Blue Cross and Blue Shield Plan. If you dispute
the coverage or payment determination of another Blue Cross and Blue Shield plan,
you must pursue appeals or other legal remedies with the applicable Blue Cross and
Blue Shield Home Plan, not with Arkansas Blue Cross and Blue Shield.
Arkansas Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association and is licensed to offer health plans in all 75 counties of Arkansas.
Copyright © 2001-2016 Arkansas Blue Cross and Blue Shield